CQ HealthBeat Examines PEPFAR’s ProgressCQ HealthBeat on Monday examined how the President's Emergency Plan for AIDS Relief has progressed since its launch in 2004 (Blinkhorn, CQ HealthBeat, 5/7). Ambassador Mark Dybul, who serves as the U.S. global AIDS coordinator and administers PEPFAR, last month at a House Committee on Foreign Affairs hearing said that the program is on track to reach its goals. As of September 2006, about 822,000 people were receiving access to antiretroviral drugs with PEPFAR support, Dybul said. He added that 61.5 million people had been reached by HIV/AIDS prevention campaigns. Some committee members raised concerns about recommendations in a recent Institute of Medicine report that Congress eliminate all budget allocations in PEPFAR, including spending requirements for prevention efforts and abstinence and fidelity programs. Dybul said such funding allocations have been useful in addressing HIV/AIDS prevention issues, adding that PEPFAR allows each focus country to develop its own HIV/AIDS prevention strategy. Dybul said some PEPFAR-funded laboratories currently are used to diagnose tuberculosis. However, he said it would be years before the use of new technologies, such as an HIV/AIDS vaccine and microbicides, could be put into place. He also said that PEPFAR is examining circumcision programs following recent studies that found male circumcision can reduce significantly a man's risk of HIV infection through heterosexual sex (Kaiser Daily HIV/AIDS Report, 4/25).
According to CQ HealthBeat, PEPFAR often is considered an "unprecedented aid approach" that uses a country-based system allowing recipients to create specific plans customized to local needs and priorities. According to Dybul, PEPFAR works in partnership with focus countries and not in the traditional model with donors setting standards for recipient countries. PEPFAR-funded programs in Vietnam recently started supporting substitution therapy for injection drug users to help curb the spread of HIV, CQ HealthBeat reports. In addition, PEPFAR in Haiti works with a USAID microfinance program that provides women who receive loans with HIV/AIDS information.
Dybul said the biggest challenge in fighting HIV/AIDS is "vision," adding, "Any time something this visionary gets started, it's great up front, ... and then you start dealing with the bureaucracies and the politics, and things start breaking down. And then you don't have that matching vision in the rest of the world."
According to CQ HealthBeat, some international development workers are concerned that the program's "high visibility siphons attention and resources away from more basic, but highly critical, issues," such as poverty and childhood diseases. Smita Baruah, senior policy associate for government relations at the Global Health Council, said, "PEPFAR needs to be more in-sync with other health and (poverty reduction) goals," such as allowing funds to be spent on child immunizations and prenatal care for HIV-positive women. Baruah added, "To treat HIV patients, you need clean water, nutrition and basic health services" (CQ HealthBeat, 5/7). This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.